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Jamshaid W, Jamshaid M, Coulson C, Sharma N, Muzaffar J, Nieto H. A systematic review on the efficacy of tranexamic acid in head and neck surgery. Clin Otolaryngol 2023. [PMID: 37042081 DOI: 10.1111/coa.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/08/2023] [Accepted: 02/19/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Intraoperative and postoperative blood loss is a major risk in head and neck (H&N) surgery. Recently the use of tranexamic acid (TXA) has been investigated by multiple studies for reducing intraoperative and postoperative bleeding, however reported results are variable. OBJECTIVES To determine the safety and efficacy of TXA use in H&N surgery. METHODS Systematic review of MEDLINE, EMBASE, CINAHL, Cochrane Library, PubMed, ClinicalKey, and Clinicaltrials.gov according to the PRISMA guidelines. Studies were included if they reported on intraoperative bleeding, volume or duration of postoperative drain or return to theatre rate for postoperative haemorrhage in adult populations following use of TXA. Risk of bias assessment with Cochrane Risk of Bias (RoB2) tool for randomised controlled trials and Newcastle-Ottawa Scale tool for non-randomised studies. RESULTS Sixteen studies were identified (114 407 patients). Eight studies evaluated TXA in major H&N surgery and eight studies in tonsillectomy. Primary outcomes were reduction in intraoperative or postoperative bleeding. Secondary outcomes included the duration of postoperative drain placement and return to theatre rate. No adverse events were reported in any patients. TXA is effective in reducing intraoperative blood loss in tonsillectomy. However, the effect on posttonsillectomy haemorrhage was unclear. Insufficient evidence exists of benefit of TXA on intraoperative bleeding in major H&N procedures. Postoperative drainage volumes were significantly reduced in most major H&N studies. The duration of drain placement and risk of blood transfusion was unchanged in most cases. CONCLUSION TXA use is safe in H&N patients. Whilst sufficient evidence exists to support the use of TXA in tonsillectomy, insufficient evidence exists to recommend use in major H&N surgery.
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Affiliation(s)
- Warda Jamshaid
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | - Chris Coulson
- Department of Ear, Nose and Throat Surgery, University Hospitals Birmingham NHS Foundation, UK
| | - Neil Sharma
- Department of Ear, Nose and Throat Surgery, University Hospitals Birmingham NHS Foundation, UK
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - Jameel Muzaffar
- Department of Clinical Neurosciences, University of Cambridge Trust, Cambridge, UK
| | - Hannah Nieto
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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Metcalfe C, Gaskell P, McLelland T, Patel S, Muzaffar J, Dalton L, Coulson C. A retrospective cohort study of telephone versus face-to-face clinics for the management of new otology referrals. Eur Arch Otorhinolaryngol 2023; 280:1677-1682. [PMID: 36109380 PMCID: PMC9483526 DOI: 10.1007/s00405-022-07653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare outcomes of telephone and face-to-face consultations for new otology referrals and discuss the wider use of telemedicine in otology. METHODS Retrospective cohort study including new adult otology referrals to our unit, sampled consecutively between March 2021 and May 2021, seen in either a face-to-face or telephone clinic. Primary outcome measure was the proportion of patients with a definitive management outcome (discharged or added to waiting list for treatment) versus the proportion of patients requiring follow-up for further assessment or review. RESULTS 150 new patients referred for a routine otology consultation (75 telephone, 75 face-to-face) were included. 53/75 patients (71%) undergoing a face-to-face consultation received a definitive outcome following initial review, versus 22/75 (29%) telephone patients (χ2 < 0.001, OR 5.8). 52/75 (69%) telephone patients were followed up face-to-face for examination. The mean (SD) number of appointments required to reach a definitive outcome was 1.22 (0.58) and 1.75 (0.73) in the face-to-face and telephone cohorts, respectively (p < 0.001). CONCLUSIONS Telephone clinics in otology have played an important role as part of the COVID19 response. However, they are currently limited by a lack of clinical examination and audiometry. Remote assessment pathways in otology that incorporate asynchronous review of recorded examinations alongside audiometry, either conventional or boothless, may mitigate this problem; however, further research is required.
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Affiliation(s)
- Christopher Metcalfe
- Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK.
| | - Peter Gaskell
- Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK
| | - Thomas McLelland
- Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK
| | - Sanjay Patel
- Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK
| | - Jameel Muzaffar
- Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK
| | - Lucy Dalton
- Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK
| | - Chris Coulson
- Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK
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Hafeez N, Du X, Boulgouris N, Begg P, Irving R, Coulson C, Tourrel G. Electrical impedance guides electrode array in cochlear implantation using machine learning and robotic feeder. Hear Res 2021; 412:108371. [PMID: 34689069 DOI: 10.1016/j.heares.2021.108371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 09/22/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
Cochlear Implant provides an electronic substitute for hearing to severely or profoundly deaf patients. However, postoperative hearing outcomes significantly depend on the proper placement of electrode array (EA) into scala tympani (ST) during cochlear implant surgery. Due to limited intra-operative methods to access array placement, the objective of the current study was to evaluate the relationship between EA complex impedance and different insertion trajectories in a plastic ST model. A prototype system was designed to measure bipolar complex impedance (magnitude and phase) and its resistive and reactive components of electrodes. A 3-DoF actuation system was used as an insertion feeder. 137 insertions were performed from 3 different directions at a speed of 0.08 mm/s. Complex impedance data of 8 electrode pairs were sequentially recorded in each experiment. Machine learning algorithms were employed to classify both the full and partial insertion lengths. Support Vector Machine (SVM) gave the highest 97.1% accuracy for full insertion. When a real-time prediction was tested, Shallow Neural Network (SNN) model performed better than other algorithms using partial insertion data. The highest accuracy was found at 86.1% when 4 time samples and 2 apical electrode pairs were used. Direction prediction using partial data has the potential of online control of the insertion feeder for better EA placement. Accessing the position of the electrode array during the insertion has the potential to optimize its intraoperative placement that will result in improved hearing outcomes.
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Affiliation(s)
- Nauman Hafeez
- Institute of Environment, Health and Societies, Brunel University, London, UB8 3PH, UK.
| | - Xinli Du
- Institute of Environment, Health and Societies, Brunel University, London, UB8 3PH, UK
| | - Nikolaos Boulgouris
- Institute of Environment, Health and Societies, Brunel University, London, UB8 3PH, UK
| | - Philip Begg
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
| | - Richard Irving
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
| | - Chris Coulson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
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Hou L, Du X, Boulgouris NV, Hafeez N, Coulson C, Irving R, Begg P, Brett P. A Capacitive Cochlear Implant Electrode Array Sensing System to Discriminate Fold-Over Pattern. J Speech Lang Hear Res 2021; 64:3685-3696. [PMID: 34407380 DOI: 10.1044/2021_jslhr-21-00067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose During insertion of the cochlear implant electrode array, the tip of the array may fold back on itself and can cause serious complications to patients. This article presents a sensing system for cochlear implantation in a cochlear model. The electrode array fold-over behaviors can be detected by analyzing capacitive information from the array tip. Method Depending on the angle of the array tip against the cochlear inner wall when it enters the cochlear model, different insertion patterns of the electrode array could occur, including smooth insertion, buckling, and fold-over. The insertion force simulating the haptic feedback for surgeons and bipolar capacitance signals during the insertion progress were collected and compared. The Pearson correlation coefficient (PCC) was applied to the collected capacitive signals to discriminate the fold-over pattern. Results Forty-six electrode array insertions were conducted and the deviation of the measured insertion force varies between a range of 20% and 30%. The capacitance values from electrode pair (1, 2) were recorded for analyzing. A threshold for the PCC is set to be 0.94 that can successfully discriminate the fold over insertions from the other two types of insertions, with a success rate of 97.83%. Conclusions Capacitive measurement is an effective method for the detection of faulty insertions and the maximization of the outcome of cochlear implantation. The proposed capacitive sensing system can be used in other tissue implants in vessels, spinal cord, or heart.
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Affiliation(s)
- Lei Hou
- Brunel University London, United Kingdom
| | - Xinli Du
- Brunel University London, United Kingdom
| | | | | | - Chris Coulson
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, United Kingdom
| | - Richard Irving
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, United Kingdom
| | - Philip Begg
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, United Kingdom
| | - Peter Brett
- University of Southern Queensland, Toowoomba, Australia
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Williams R, Lee JDE, Muzaffar J, Clutton-Brock T, Coulson C. Usability and Practicality of a Novel Mobile Attachment for Aural Endoscopy (endoscope-i): Formative Usability Study. JMIR Biomed Eng 2020. [DOI: 10.2196/18850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background
Our aims were to determine the usability and practicality of the endoscope-i system, a novel mobile attachment for aural endoscopy. This incorporated assessing the ease of use of the endoscope-i for different professionals, and ultimately improving the system by receiving constructive feedback.
Objective
Our objectives were to assess the ease of the endoscope-i system in conducting an aural examination and to assess its feasibility for integrating its use into clinical practice. We looked to assess its ease, effectiveness, and efficiency; to compare this to current practices with otoscopes; and to determine whether participants perceived the system to be able to produce an image of sufficient quality to make a clinical assessment. Finally, we wanted to assess the usefulness of the current training given for using the system, and we sought to gain feedback for the product from the differing specialists.
Methods
A formative usability study of the endoscope-i system was conducted with 5 health care professionals. Each session lasted 40 minutes and involved audio/video consent, a hands-on session, a private semistructured interview, and an option to discuss the device with a company representative.
Results
All participants found the endoscope-i system easy to use. The image quality was perceived to be greater than that achieved by current otoscopes. The ability to record images and view them retrospectively was also seen as a positive.
Conclusions
This study has not identified any significant issues relating to the design, functionality, or application of the endoscope-i. Participants perceived the system as superior to current options with a directly positive impact on their clinical practice.
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Shahidi S, Nassimizadeh A, Coulson C. Treating twenty-five cases of chronic resistant otitis externa with fluticasone propionate (Flixonase ® ): A case series. Clin Otolaryngol 2020; 46:75-78. [PMID: 32770842 DOI: 10.1111/coa.13628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 11/30/2022]
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George A, Prince M, Coulson C. Safe nasendoscopy assisted procedure in the post-COVID-19 pandemic era. Clin Otolaryngol 2020; 45:844-846. [PMID: 32475011 PMCID: PMC7301020 DOI: 10.1111/coa.13591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/17/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ajith George
- University Hospital North Midlands, Stoke on Trent, UK.,Endoscope-i Ltd, Birmingham, UK
| | | | - Chris Coulson
- Endoscope-i Ltd, Birmingham, UK.,University Hospitals Birmingham, Birmingham, UK
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Cottrell E, George A, Coulson C, Chambers R. Telescopic otology referrals: Evaluation of feasibility and acceptability. Laryngoscope Investig Otolaryngol 2020; 5:221-227. [PMID: 32337353 PMCID: PMC7178442 DOI: 10.1002/lio2.367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/22/2020] [Accepted: 02/08/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE A remote telemedical otology referral and advice service was introduced to interested general practices. General practitioners (GPs) were given a new device, "endoscope-i" that combines an optimized smartphone high definition video app with an otoendoscope. They were specifically trained to examine and capture images of patients' eardrums, which were sent electronically with a summary of clinical information and an in-app hearing testing (if required), for specialist advice to two ear, nose, and throat (ENT) consultants. We describe the findings from an evaluation of the first 6 months of this service to establish the feasibility and acceptability of an otology telemedical referral and advice service. METHODS The new service was advertised to GP practices in Northern Staffordshire. All interested GPs were provided with training and equipment to deliver the remote referral service. Data were collected from GPs at baseline, informal feedback in response to referral outcomes and end of service feedback. Referral data were collected routinely during the service delivery. RESULTS Fifteen GP leads from 15 practices received training and equipment. One quickly lost the equipment. Of the remaining 14 practices, eight sent a total of 53 remote referrals using this technology over 6 months. The most common reason for referral was an uncertainty of what could be seen in or around the eardrum. The primary barrier for implementation was lack of wireless internet connections within practices. GPs reported that they used this technology to share examination findings with patients. CONCLUSIONS GPs were positive about the technology, from initial engagement with training and after advice were given. Some GPs expanded the role of the technology to a consultation aid. Referral volume was manageable. Commissioners should consider tariffs structures for such services; empirical cost-effectiveness and workload-impact evaluation would inform this.
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Affiliation(s)
| | - Ajith George
- Department of ENT University Hospital of North Midlands UK
| | - Chris Coulson
- Department of ENT Queen Elizabeth Hospital Birmingham UK
| | - Ruth Chambers
- Staffordshire Sustainability & Transformation Partnership Clinical Lead for Technology Enabled Care Services, Digital Workstream UK
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Abstract
Background An arm supported robotic drill has been recently demonstrated for preparing cochleostomies in a pilot research clinical trial. In this paper, a hand-guided robotic drill is presented and tested on human cadaver trials. Methods The innovative smart tactile approach can automatically detect drilling mediums and decided when to stop drilling to prevent penetrating the endosteum. The smart sensing scheme has been implemented in a concept of a hand guided robotic drill. Results Experiments were carried out on two adult cadaveric human bodies for verifying the drilling process and successfully finished cochleostomy on three cochlea. The advantage over a system supported by a mechanical arm includes the flexibility in adjusting the trajectory to initiate cutting without slipping. Using the same concept as a conventional drilling device, the user will also be benefit from the lower setup time and cost, and lower training overhead. Conclusion The hand-guided robotic drill was recently developed for testing on human cadavers. The robotic drill successfully prepared cochleostomies in all three cases.
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Affiliation(s)
- Xinli Du
- Brunel Institute for Bioengineering, Brunel University London, Uxbridge, UK,
| | - Peter N Brett
- University of Southern Queensland, Toowoomba, QLD, Australia
| | - Yu Zhang
- Brunel Institute for Bioengineering, Brunel University London, Uxbridge, UK,
| | - Philip Begg
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Chris Coulson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Irving
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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10
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Gaskell P, Muzaffar J, Colley S, Coulson C. Can Preoperative High Resolution Computed Tomography Be Rationalized in Adult Cochlear Implant Candidates? Otol Neurotol 2018; 39:1264-1270. [DOI: 10.1097/mao.0000000000002027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Heining C, Tikka T, Colley S, Zilinskiene L, Coulson C. A Comparison of Cochlear Nerve Size in Normal-Hearing Adults Using Magnetic Resonance Imaging. J Int Adv Otol 2017; 13:300-303. [PMID: 29283094 DOI: 10.5152/iao.2017.4170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Cochlear implantation is a clinical and cost-effective treatment for severe hearing loss. Cochlear nerve size assessment by magnetic resonance imaging (MRI) has been investigated for use as a prognostic indicator following cochlear implantation. This study aimed to further that research by assessing nerve size in normal-hearing adults for symmetry. MATERIALS AND METHODS Patients with tinnitus presenting to our center retrospectively had their nerve size assessed by MRI. RESULTS The study found no significant differences between right and left cochlear nerves in normal-hearing adults, supporting our hypothesis of symmetry in these individuals. This was a previously unproven and uninvestigated hypothesis. CONCLUSION Nerve size assessment should remain an active area of research in otological disease.
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Affiliation(s)
- Christoper Heining
- Department of Ear, Nose and Throat, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Theofano Tikka
- Department of Ear, Nose and Throat, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Steve Colley
- Department of Radiology, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Laura Zilinskiene
- Department of Radiology, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Chris Coulson
- Department of Ear, Nose and Throat, University Hospitals Birmingham, Birmingham, United Kingdom
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Mistry N, Coulson C, George A. endoscope-i: an innovation in mobile endoscopic technology transforming the delivery of patient care in otolaryngology. Expert Rev Med Devices 2017; 14:913-918. [PMID: 28972409 DOI: 10.1080/17434440.2017.1386548] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Digital and mobile device technology in healthcare is a growing market. The introduction of the endoscope-i, the world's first endoscopic mobile imaging system, allows the acquisition of high definition images of the ear, nose and throat (ENT). The system combines the e-i Pro camera app with a bespoke engineered endoscope-i adaptor which fits securely onto the iPhone or iPod touch. Endoscopic examination forms a salient aspect of the ENT work-up. The endoscope-i therefore provides a mobile and compact alternative to the existing bulky endoscopic systems currently in use which often restrict the clinician to the clinic setting. Areas covered: This article gives a detailed overview of the endoscope-i system together with its applications. A review and comparison of alternative devices on the market offering smartphone adapted endoscopic viewing systems is also presented. Expert commentary: The endoscope-i fulfils unmet needs by providing a compact, highly portable, simple to use endoscopic viewing system which is cost-effective and which makes use of smartphone technology most clinicians have in their pocket. The system allows real-time feedback to the patient and has the potential to transform the way that healthcare is delivered in ENT as well as having applications further afield.
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Affiliation(s)
- N Mistry
- a University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - C Coulson
- a University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - A George
- b University Hospitals of North Midlands NHS Trust , Stoke , UK
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13
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Hoskison E, Mitchell S, Coulson C. Systematic review: Radiological and histological evidence of cochlear implant insertion trauma in adult patients. Cochlear Implants Int 2017; 18:192-197. [DOI: 10.1080/14670100.2017.1330735] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Emma Hoskison
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, 58 Barcheston Road, Solihull, Knowle, Birmingham, UK
| | - Scott Mitchell
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, 58 Barcheston Road, Solihull, Knowle, Birmingham, UK
| | - Chris Coulson
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, 58 Barcheston Road, Solihull, Knowle, Birmingham, UK
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Muzaffar J, Metcalfe C, Colley S, Coulson C. Diffusion-weighted magnetic resonance imaging for residual and recurrent cholesteatoma: a systematic review and meta-analysis. Clin Otolaryngol 2016; 42:536-543. [DOI: 10.1111/coa.12762] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2016] [Indexed: 12/16/2022]
Affiliation(s)
- J. Muzaffar
- Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - C. Metcalfe
- Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - S. Colley
- Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - C. Coulson
- Queen Elizabeth Hospital Birmingham; Birmingham UK
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15
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Danino J, Muzaffar J, Metcalfe C, Coulson C. Patient safety in otolaryngology: a descriptive review. Eur Arch Otorhinolaryngol 2016; 274:1317-1326. [PMID: 27623822 DOI: 10.1007/s00405-016-4291-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/31/2016] [Indexed: 11/30/2022]
Abstract
Human evaluation and judgement may include errors that can have disastrous results. Within medicine and healthcare there has been slow progress towards major changes in safety. Healthcare lags behind other specialised industries, such as aviation and nuclear power, where there have been significant improvements in overall safety, especially in reducing risk of errors. Following several high profile cases in the USA during the 1990s, a report titled "To Err Is Human: Building a Safer Health System" was published. The report extrapolated that in the USA approximately 50,000 to 100,000 patients may die each year as a result of medical errors. Traditionally otolaryngology has always been regarded as a "safe specialty". A study in the USA in 2004 inferred that there may be 2600 cases of major morbidity and 165 deaths within the specialty. MEDLINE via PubMed interface was searched for English language articles published between 2000 and 2012. Each combined two or three of the keywords noted earlier. Limitations are related to several generic topics within patient safety in otolaryngology. Other areas covered have been current relevant topics due to recent interest or new advances in technology. There has been a heightened awareness within the healthcare community of patient safety; it has become a major priority. Focus has shifted from apportioning blame to prevention of the errors and implementation of patient safety mechanisms in healthcare delivery. Type of Errors can be divided into errors due to action and errors due to knowledge or planning. In healthcare there are several factors that may influence adverse events and patient safety. Although technology may improve patient safety, it also introduces new sources of error. The ability to work with people allows for the increase in safety netting. Team working has been shown to have a beneficial effect on patient safety. Any field of work involving human decision-making will always have a risk of error. Within Otolaryngology, although patient safety has evolved along similar themes as other surgical specialties; there are several specific high-risk areas. Medical error is a common problem and its human cost is of immense importance. Steps to reduce such errors require the identification of high-risk practice within a complex healthcare system. The commitment to patient safety and quality improvement in medicine depend on personal responsibility and professional accountability.
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Affiliation(s)
- Julian Danino
- Queen Elizabeth Hospital Birmingham, Birmingham, B15 2TH, England, UK.
| | - Jameel Muzaffar
- Queen Elizabeth Hospital Birmingham, Birmingham, B15 2TH, England, UK
| | - Chris Metcalfe
- Queen Elizabeth Hospital Birmingham, Birmingham, B15 2TH, England, UK
| | - Chris Coulson
- Queen Elizabeth Hospital Birmingham, Birmingham, B15 2TH, England, UK
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Taylor RR, Jagger DJ, Saeed SR, Axon P, Donnelly N, Tysome J, Moffatt D, Irving R, Monksfield P, Coulson C, Freeman SR, Lloyd SK, Forge A. Characterizing human vestibular sensory epithelia for experimental studies: new hair bundles on old tissue and implications for therapeutic interventions in ageing. Neurobiol Aging 2015; 36:2068-84. [PMID: 25818177 PMCID: PMC4436436 DOI: 10.1016/j.neurobiolaging.2015.02.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/09/2015] [Accepted: 02/11/2015] [Indexed: 12/19/2022]
Abstract
Balance disequilibrium is a significant contributor to falls in the elderly. The most common cause of balance dysfunction is loss of sensory cells from the vestibular sensory epithelia of the inner ear. However, inaccessibility of inner ear tissue in humans severely restricts possibilities for experimental manipulation to develop therapies to ameliorate this loss. We provide a structural and functional analysis of human vestibular sensory epithelia harvested at trans-labyrinthine surgery. We demonstrate the viability of the tissue and labeling with specific markers of hair cell function and of ion homeostasis in the epithelium. Samples obtained from the oldest patients revealed a significant loss of hair cells across the tissue surface, but we found immature hair bundles present in epithelia harvested from patients >60 years of age. These results suggest that the environment of the human vestibular sensory epithelium could be responsive to stimulation of developmental pathways to enhance hair cell regeneration, as has been demonstrated successfully in the vestibular organs of adult mice.
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Affiliation(s)
| | | | - Shakeel R Saeed
- UCL Ear Institute, London, UK; Royal National Throat Nose and Ear Hospital, UCLH NHS Foundation Trust, London, UK
| | - Patrick Axon
- Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Neil Donnelly
- Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - James Tysome
- Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - David Moffatt
- Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Richard Irving
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Birmingham, UK
| | - Peter Monksfield
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Birmingham, UK
| | - Chris Coulson
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Birmingham, UK
| | - Simon R Freeman
- Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, UK; Salford Royal Infirmary, Salford Royal NHS Foundation Trust, Salford, UK
| | - Simon K Lloyd
- Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, UK; Salford Royal Infirmary, Salford Royal NHS Foundation Trust, Salford, UK
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Erovic BM, Chan HHL, Daly MJ, Pothier DD, Yu E, Coulson C, Lai P, Irish JC. Intraoperative Cone-Beam Computed Tomography and Multi-Slice Computed Tomography in Temporal Bone Imaging for Surgical Treatment. Otolaryngol Head Neck Surg 2013; 150:107-14. [DOI: 10.1177/0194599813510862] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Conventional computed tomography (CT) imaging is the standard imaging technique for temporal bone diseases, whereas cone-beam CT (CBCT) imaging is a very fast imaging tool with a significant less radiation dose compared with conventional CT. We hypothesize that a system for intraoperative cone-beam CT provides comparable image quality to diagnostic CT for identifying temporal bone anatomical landmarks in cadaveric specimens. Study Design Cross-sectional study. Setting University tertiary care facility. Subjects and Methods Twenty cadaveric temporal bones were affixed into a head phantom and scanned with both a prototype cone-beam CT C-arm and multislice helical CT. Imaging performance was evaluated by 3 otologic surgeons and 1 head and neck radiologist. Participants were presented images in a randomized order and completed landmark identification questionnaires covering 21 structures. Results CBCT and multislice CT have comparable performance in identifying temporal structures. Three otologic surgeons indicated that CBCT provided statistically equivalent performance for 19 of 21 landmarks, with CBCT superior to CT for the chorda tympani and inferior for the crura of the stapes. Subgroup analysis showed that CBCT performed superiorly for temporal bone structures compared with CT. The radiologist rated CBCT and CT as statistically equivalent for 18 of 21 landmarks, with CT superior to CBCT for the crura of stapes, chorda tympani, and sigmoid sinus. Conclusion CBCT provides comparable image quality to conventional CT for temporal bone anatomical sites in cadaveric specimens. Clinical applications of low-dose CBCT imaging in surgical planning, intraoperative guidance, and postoperative assessment are promising but require further investigation.
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Affiliation(s)
- Boban M. Erovic
- Otolaryngology–Head and Neck Surgery, University Health Network, Toronto, Canada
- Surgical Oncology, University Health Network, Toronto, Canada
| | - Harley H. L. Chan
- GTx Core-TECHNA Institute, Princess Margaret Hospital, Toronto, Canada
| | - Michael J. Daly
- GTx Core-TECHNA Institute, Princess Margaret Hospital, Toronto, Canada
| | - David D. Pothier
- Otolaryngology–Head and Neck Surgery, University Health Network, Toronto, Canada
| | - Eugene Yu
- Department of Radiology, University Health Network, Toronto, Canada
| | - Chris Coulson
- Otolaryngology–Head and Neck Surgery, University Health Network, Toronto, Canada
| | - Philip Lai
- Otolaryngology–Head and Neck Surgery, University Health Network, Toronto, Canada
| | - Jonathan C. Irish
- Otolaryngology–Head and Neck Surgery, University Health Network, Toronto, Canada
- GTx Core-TECHNA Institute, Princess Margaret Hospital, Toronto, Canada
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George A, Prince M, Coulson C. The ‘endoscope-i’: a mobile solution for endoscopy in otolaryngology. Clin Otolaryngol 2013; 38:104-6. [PMID: 23418978 DOI: 10.1111/coa.12062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2012] [Indexed: 11/29/2022]
Affiliation(s)
- A. George
- Department of Otolaryngology; West Midlands Deanery; Birmingham; UK
| | - M. Prince
- Department of Mechanical Engineering; Aston University; Birmingham; UK
| | - C. Coulson
- Department of Otolaryngology; Queen Elizabeth Hospital; Birmingham; UK
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Lee M, Dawes S, Douglas J, Al Hamarneh O, Bickerton R, Coulson C. Incidental Findings on MRI Internal Acoustic Meatus (IAM) in ENT Outpatients. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1314273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lai P, Coulson C, Pothier D, Rutka J. Chlorhexidine ototoxicity in ear surgery part II: survey of preparation solution used by otolaryngologists in Canada: is there a cause for concern? J Otolaryngol Head Neck Surg 2011; 40:441-445. [PMID: 22420429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE To conduct a survey of the antiseptic preparations used for ear surgeries among otolaryngologists in Canada. METHODS An electronic survey was sent to active members of the Canadian Society of Otolaryngology-Head and Neck Surgery via e-mail. Questions included the use of antiseptic, choice of preparation solution, duration of preparation, use of a barrier method, and compliance with hospital protocol changes. RESULTS The e-mail was received by 253 otolaryngologists, and 85 completed the survey. Four of 85 respondents did not perform tympanoplasty surgery and were not included in the analysis. Of those who performed tympanoplasty (n = 81), 78 of the 81 respondents (96%) used an antiseptic preparation solution at surgery, whereas 3 respondents (4%) did not. Sixty-six of the 77 respondents (86%) used aqueous povidone-iodine, 4 (5%) used a chlorhexidine-based preparation, 3 (4%) used an alcohol-based solution, 3 (4%) used others, and 1 answered "I don't know." Thirty-eight of 75 (29%) respondents used a barrier method, 23 (31%) answered "always," 18 (24%) answered "sometimes," and 5 (7%) answered "I don't know." When asked if they would comply with a hypothetical hospital policy to use chlorhexidine in ear surgery, 15 of 79 (19%) respondents agreed, whereas 64 (81%) disagreed. Among the aqueous povidone-iodine users (n = 66), 7 (11%) agreed to change to chlorhexidine. CONCLUSIONS There is a wide variation in practice in the use of surgical preparation solution among otolaryngologists performing ear surgery. Surgeons must be vigilant to avoid ototoxicity. A national society consensus on appropriate preparation solutions for ear surgery would minimize patients' risk and minimize future medicolegal actions.
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Affiliation(s)
- Philip Lai
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto
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Lai P, Coulson C, Pothier DD, Rutka J. Chlorhexidine ototoxicity in ear surgery, part 1: review of the literature. J Otolaryngol Head Neck Surg 2011; 40:437-440. [PMID: 22420428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE Chlorhexidine is a common antiseptic used to prevent surgical infection. However, its exposure to the middle ear may lead to deafness. The mechanisms of the ototoxicity of chlorhexidine are reviewed. The importance of recognizing its toxicity cannot be overstated in preventing injury to patients undergoing ear surgery. METHODS A systematic literature search was performed looking at data from human and animal studies. Search engines included MEDLINE, EMBASE, The Cochrane Library, CENTRAL, CINAHL, and Web of Science to November 1, 2010, for relevant studies published in all languages. Two independent reviewers (P.L. and D.D.P.) screened the references from published articles for additional relevant studies. Medical Subject Headings and key words including intervention (chlorhexidine, antiseptic), exposure (myringoplasty, intratympanic), and adverse effects (sensorineural hearing loss, ototoxicity, vestibular toxicity) were used. RESULTS Twelve studies were identified, two of which were non-English and were excluded. Only 2 articles on human subjects and 12 articles on animal models concerning chlorhexidine ototoxicity were identified. CONCLUSIONS Chlorhexidine in both human studies and animal models demonstrates ototoxicity if it reaches the inner ear. The toxicity of chlorhexidine appears to be related to its concentration and probable contact time with the round window membrane intraoperatively. It is conceivable that the incidence of chlorhexidine toxicity may be higher than stated if unrecognized or has resulted in subsequent medicolegal actions. From the evidence available, safer preparation solutions are available without clinical risks for ototoxicity should surgeons continue with this practice.
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Affiliation(s)
- Philip Lai
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, ON
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Beech T, Coulson C, Najran P, Olliff J, Jennings C. How good is a chest CT scan at predicting the risk of pulmonary metastatic disease in patients with head and neck cancer? A retrospective observational study. Clin Otolaryngol 2010; 35:474-8. [DOI: 10.1111/j.1749-4486.2010.02198.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
The standard current treatment of an otogenic brain abscess is drainage via neurosurgical burr hole or complete excision, followed by an otological procedure to eradicate the primary pathology – often at a later date. We describe the drainage of otogenic brain abscess via a transtemporal approach. We present a retrospective study of six cases, five children and one adult. All the children had acute middle ear disease while the adult patient had a petrous apex cholesteatoma. All cases had an otogenic intracranial abscess either in the posterior cranial fossa or in both posterior and middle cranial fossae. Diagnosis was confirmed by computed axial tomography (CT) scan. All the patients were treated by mastoidectomy and needle aspiration to drain the abscesses. In all cases the brain abscess and the ear pathology were successfully treated by a single stage transmastoid approach. The five paediatric patients had an extended cortical mastoidectomy approach to both intracranial pathology and ear disease except one patient who required a burr hole to drain a posteriorly located subdural posterior fossa abscess. The adult patient underwent petrosectomy, followed by transtemporal abscess drainage. There was postoperative pus recollection in one patient who required further aspiration. We conclude that transtemporal drainage of an otogenic brain abscess can successfully treat otological and intracranial pathology in a single operation. It has a low complication rate and avoids the need for a craniotomy or subsequent operations.
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Affiliation(s)
- Ausama Alaani
- ENT Department, University Hospitals Birmingham, Birmingham Children Hospital, UK.
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Doshi J, Coulson C, Williams J, Kuo M. Response to Howe et al.. Clin Otolaryngol 2009. [DOI: 10.1111/j.1749-4486.2009.01992.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- J Doshi
- Department of Otolaryngology, Birmingham Children's Hospital, Birmingham, UK.
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Reardon DJ, Freschini A, Harrison M, Coulson C, Nangalia LL. Oesophageal dilatation due to a paraoesophageal hernia and gastric volvulus as a cause of stridor. Case Reports 2009; 2009:bcr2006049916. [DOI: 10.1136/bcr.2007.049916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Brett PN, Taylor RP, Proops D, Coulson C, Reid A, Griffiths MV. A surgical robot for cochleostomy. Annu Int Conf IEEE Eng Med Biol Soc 2008; 2007:1229-32. [PMID: 18002185 DOI: 10.1109/iembs.2007.4352519] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this paper a robotic micro-drilling technique for surgery is described. The device has been deployed in cochleostomy, a precise micro-surgical procedure where the critical stage of controlling penetration of the outer bone tissue of the cochlea is achieved without penetration of the endosteal membrane at the medial surface. The significance of the work is that the device navigates by using transients of the reactive drilling forces to discriminate cutting conditions, state of tissue and the detection of the medial surface before drill break-out occurs. This is the first autonomous surgical robot to use this technique in real-time as a navigation function in the operating room and unlike other fully autonomous surgical robotic processes it is carried out without the use pre-operative data to control the motion of the tool. To control tool points in flexible tissues requires self-referencing to the tissue position in real time. There is also the need to discriminate deflections of the tissue, tissue interface, involuntary patients/tissue movement and indeed movement induced by the drill itself, which require different strategies to be selected for control. As a result of the design of the final system, the break-out process of the drill can either controlled to the required level of protrusion through the flexible interface or can be avoided altogether, with the drill bit at the medial surface. This enables, for the first time, the control of fine penetration with such great precision.
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Coulson C, George A, Biswas A, Phelan C, De R. Pseudotumour of the temporal bone: an unusual cause of otorrhoea and facial palsy. Eur Arch Otorhinolaryngol 2007. [DOI: 10.1007/s00405-007-0553-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
OBJECTIVES To determine how nasal injuries are managed by accident and emergency (A&E) consultants and produce a management protocol if the survey indicated a need. METHOD A postal survey of UK A&E consultants. RESULTS The response rate was 59%. A great deal of variation was found between departments and clinicians regarding the training of junior A&E staff, the equipment available, the management strategies employed, and the reasons for referral to ENT or maxillofacial departments. CONCLUSIONS This survey shows that many more nasal injuries could be managed within the A&E setting without referral to ENT or maxillofacial departments. A flow chart of the optimal management of nasal injuries in Accident and Emergency departments is presented.
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Affiliation(s)
- C Coulson
- Otolaryngology Specialist Registrar Rotation, West Midlands, UK.
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Affiliation(s)
- C Coulson
- Centre for Reproductive Medicine, 4 Priory Rd, Clifton, Bristol BS8 1TY, UK
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Abstract
Cystic lymphangiomas are congenital malformations of the lymphatic system that occur most commonly in the nuchal region. Nuchal lymphangiomas are often referred to as cystic hygromas. Few cases of axillary cystic lymphangioma have been reported, but the prognosis of this lesion appears to be less grave than that of its nuchal counterpart. We present 2 cases of axillary cystic lymphangiomas that were diagnosed on prenatal sonography. In 1 case, prenatal sonography showed a multilocular, large cystic mass on the fetal left side, in the area of the lower chest and upper abdomen. The mass extended from at least the level of the umbilicus up to the neck but did not involve the neck. In the second case, prenatal sonography showed a multilocular, septate axillary cystic lymphangioma external to the chest with no flow on Doppler sonography. Follow-up sonography revealed normal fetal growth and enlargement of the cystic mass surrounding the left humerus. Both infants were delivered without complications and have been managed conservatively.
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Affiliation(s)
- S D Zanotti
- Department of Obstetrics and Gynecology, Milton S. Hershey Medical Center, Penn State University, Hershey, Pennsylvania 17033, USA
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Coulson C, McLaughlin EA, Harris S, Ford WC, Hull MG. Randomized controlled trial of cervical cap with intracervical reservoir versus standard intracervical injection to inseminate cryopreserved donor semen. Hum Reprod 1996; 11:84-7. [PMID: 8671164 DOI: 10.1093/oxfordjournals.humrep.a019044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A prospective controlled study of donor insemination without sperm preparation or ovarian stimulation was performed to compare the use of a cervical cap incorporating an intracervical reservoir with a standard intracervical injection technique to inseminate 0.5 ml cryopreserved semen. Treatments were alternated in successive cycles in each patient after initial randomized selection. A total of 198 patients had 635 treatment cycles (median 3, range 1-7), 309 with reservoir and 326 by standard injection. A total of 56 women became pregnant, 24 (7.8% per cycle) with the reservoir and 32 (9.8% per cycle) by injection. There were no significant differences between the pregnancy rates per cycle overall or cycle-specific cumulative rates calculated using the life-table method. There were no significant differences in age, parity, baseline gonadotrophin measurements, mid-luteal serum progesterone concentrations, frequency of adverse fertility factors in the woman or her partner's cause of infertility between women who conceived and those who failed to conceive. We conclude that use of a cervical reservoir and cap for donor insemination does not offer any advantage over standard intracervical insemination.
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Affiliation(s)
- C Coulson
- University of Bristol Department of Obstetrics and Gynaecology, St Michael's Hospital, Bristol BS2 8EG, UK
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Corrigan E, McLaughlin EA, Coulson C, Ford WC, Hull MG. The effect of halving the standard dose of cryopreserved semen for donor insemination: a controlled study of conception rates. Hum Reprod 1994; 9:330-3. [PMID: 8027291 DOI: 10.1093/oxfordjournals.humrep.a138502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Employing a common standard technique of intra-cervical insemination from straws of cryopreserved donor semen, a volume of 0.25 ml of 0.5 ml was inseminated in alternate cycles to determine if the lower volume could be used without a decrease in the conception rate. A total of 177 women were recruited and received a median of four cycles of treatment. Of these, 90 women became pregnant, 47 with 0.5 ml and 43 with 0.25 ml inseminations. The conception rates were identical for both volumes in the first nine cycles of treatment and the cumulative rates were 57.7 and 59.3%, respectively. Subsequently more pregnancies were achieved with 0.5 ml than 0.25 ml semen (nine pregnancies in 73 further cycles versus three pregnancies in 68 cycles, respectively), although the difference was not statistically significant. There were no significant differences in the women's ages, luteinizing hormone, follicle stimulating hormone, progesterone, mucus quality, mucus pH, parity or partner's diagnosis between those women who became pregnant and those who failed to conceive with either insemination dose. We conclude that the volume of semen inseminated into the cervical canal without a cervical cap can be decreased to 0.25 ml without an adverse effect on the conception rate at least in the first 9 months of treatment. This will allow more effective use to be made of valuable screened and quarantined cryopreserved semen.
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Affiliation(s)
- E Corrigan
- University of Bristol Department of Obstetrics and Gynaecology, St Michael's Hospital, UK
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Korzeniewski P, Lang SA, Grant R, Loader C, Vaghadia H, Wong D, Waters T, Merrick P, Ali MJ, Dobkowski W, Cornelius T, Hawkins R, Varkey GP, Claffey L, Plourde G, Trahan M, Morris J, Dean DM, Yamaguchi H, Harukuni I, Naito H, Chan VWS, Mati N, Seyone C, Evans D, Chung F, Joffe D, Plourde G, Villemurc C, Hong M, Milne B, Loomis C, Jhamandas K, Priddy R, Archer D, Tang T, Sabourin M, Samanini N, Cuillerier DJ, Schuben A, Awad IA, Perez-Trepichio AD, Ebrahim ZY, Bloomfield EL, Zexu F, Zhengnua G, Qing Z, Balhua S, Miller DR, Martineau RJ, Wynands JE, Hill JD, Knill RL, Skinner MI, Novick TV, McLean RF, Kolton M, Noble WH, Sullivan PJ, Cheng DCH, Chapman KR, Ong D, Roraanelli J, Smallman B, Nathan HJ, Murphy JT, Hall RI, Moffitt EA, Hudson RJ, Pascoe EA, Anderson BA, Thomson IR, Kassum DA, Shanks A, Rosenbloom M, Sidi A, Gehrig TR, Fool JM, Rush W, Martin AJ, Cooper PD, Maltby JR, Johnson D, Hurst T, Mayers I, Wigglesworth DF, Rose DK, Kay JC, Mazer CD, Yang H, Beattie WS, Doyle DJ, Demajo W, Comfort VK, Code WE, Rooney ME, Clark FJS, Sutton IR, Mutch WAC, Thomson IR, Teskey JM, Thiessen OB, Rosanbloom M, Tang TKK, Robblee JA, Nathan HJ, Wynands JE, Eagle CJ, Belenkle I, Chan KL, Tyberg JV, Stockwell M, Zintel T, Gallagher G, Kavanagh B, Sandier A, Lawson S, Chung F, Ong D, Isabel L, Trépanier CA, Campbell DC, Randall TE, Growe GH, Scarth I, Sawchuk CWT, Ong B, Unruh H, Horan T, Greengrass R, Mark D, Kitts JB, Curran MJ, Lindsay P, Polis T, Coté S, Socci M, Wiesel S, Conway JB, Seyone C, Goldberg J, Chung F, Rose DK, Cohen MM, Rogers KH, Duncan PG, Pope WDB, Tweed WA, Biehl D, Novick TV, Skinner MI, Mathieu A, Villeneuve E, Goldsmith CH, Allen GC, Smith CE, Pinchak AC, Hagen JF, Hudson JC, Gennings C, Tyler BL, Keenan RL, Chung F, Seyone C, Matl N, Ong D, Powell P, Tessler MJ, Kleiman SJ, Wiesel S, Tetzlaff JE, Yoon HJ, Baird B, Walsh M, Hondorp G, Wassef MR, Munshi C, Brooks J, Nimphius N, Tweed WA, Lee TL, Tweed WA, Phua WT, Chong KY, Lim E, Finegan BA, Coulson C, Lopaschuk GD, Clanachan AS, Fournier L, Cloutier R, Major D, Sharpe MD, Wexler HR, Dhamee MS, Rooney R, Ong SK, O’Leary E, McCarroll M, Phelan D, Young T, Coghlan D, O’Leary E, Blunnie WP, Splinter WM, Splinter WM, Ryan T, Maguire M, Bouchier-Hayes D, Cunningham AJ, Kamath MV, Fallen EL, Murkin JM, Shannon NA, Montgomery CJ, Karl HW, Raymond J, Drolet P, Tanguay M, Blaise G, Garceau D, Dumont L, Omri A, Sharkawi M, Billard V, Bourgain JL, Panos A, Mazer CD, Lichtenstein SV, Bevan JC, Popovic V, Baxter MRN, Donati F, Bevan DR, Bachman C, Kopelow M, Donen N, Umôn DT, Kemp S, Hartley E, Sikich N, Roy WL, Lerman J, Cooper RM, Yentis SM, Bissonnette B, Halpern L, Roy L, Burrows FA, Fear DW, Hillier S, Sloan M, Crawford M, Blssonnette B, Sikich N, Friedlander M, Sandier AN, Panos L, Winton T, Benureof J, Karski J, Teasdale S, Cruise C, Skala R, Zulys V, Ong D, Chow F, Packota G, Yip R, Bradley J, Arellano R, Sussman G, Sosis M, Braverman B, Sosis M, Ivankovich AD, Manganas M, Lephay A, Fournier T, Kadri N, Ossart M, Sandier AN, Turner KE, Wick V, Wherrett C, Sullivan PJ, Dyck JB, Varvel J, Shafer SL, Fiset P, Balendran P, Meistelman C, Lira E, Sloan M, Nigrovic V, Banoub M, Splinter WM, Roberts DW, Rhine EJ, MacNeill HB, Bonn GE, Clarke WM, Noel LP, Ryan T, Moriarty J, Bouchier-Hayes D, Cunningham AJ, Sandier AN, Baxter AD, Norman P, Samson B, Hull K, Chung F, Mali N, Evans D, Cruise C, Shumka D, Seyone C, Leung PT, Badner NH, Komar WE, Rajasingham M, Farren B, Vaillancourt G, Cournoyer S, Hollmann C, Breen TW, Janzen JA, Crochetiere CT, McMorland GH, Douglas MJ, Kamani AA, Arora SK, Tunstall M, Ross J, Mayer DC, Weeks SK, Norman P, Daley D, Sandier A, Guay J, Gaudreault P, Boulanger A, Tang A, Lortie L, Dupuis C, Backman SB, Bachoo M, Polosa C, Moudgil GC, Frame B, Blajchman HA, Singal DP, Albert JF, Ratcliff A, Law JC, Varvel J, Hung O, Shafer SL, Fiset P, Balendran P, Burgess PM, Doak GJ, Duke PC, Sloan PA, Mather LE, McLean CF, Rutten AJ, Nation RL, Milne RW, Runciman WB, Somoggi AA, Haack C, Shafer SL, Irish CL, Weisleider L, Mazer CD, Bell RS, Dejonckheere M, Levarlet M, d’Hollander A, Taylor RH, Sikich N, Campbell F, McLeod ME, Swartz J, Spahr-Schopfer I, McIntyre BG, Roy WL, Laycock GJA, Mitchell IM, Morton NS, Logan RW, Campbell F, Yentis SM, Fear D, Halpem L, Sloan M, Badgwell JM, Kleinman S, Yentis SM, Britton JT, Hannallah RS, Schafer PO, Norden JM, Splinter WM, Menard EA, Derdamezi JB, Ghurch JG, Britt BA, Radde IC, Sosis M, Kao YJ, Norton RG, Volgyesi GA, Spahr-Schopfer I, Sosis M, Plum M, Sosis M, Smith CE, Pinchak AC, Hancock DE, Owen P, McMeekin J, Hanson S, Cujec B, Feindel CM, Cruz J, Boylen P, Ong D, Murphy JT, Dupuis JY, Nathan HJ, Cattran C, Wynands JE, Murphy JT, Kinley CE, Sulliyan JA, Landymore RW, Robblee JA, Labow R, Buckley DN, Sharpe MD, Guiraudon G, Klein G, Yee R, Black J, Devitt JH, McLellan BA, Dubbin J, Ehrlich LE, Ralley FE, Robbins GR, Symcs JF, Bourke M, Nathan H, Wynands JE. Abstracts. Can J Anaesth 1991. [DOI: 10.1007/bf03008442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Glazener CM, Coulson C, Lambert PA, Watt EM, Hinton RA, Kelly NG, Hull MG. Clomiphene treatment for women with unexplained infertility: placebo-controlled study of hormonal responses and conception rates. Gynecol Endocrinol 1990; 4:75-83. [PMID: 2204251 DOI: 10.3109/09513599009012324] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
One hundred and eighteen patients with unexplained infertility were treated with clomiphene (Clomid, Merrell) in a randomized placebo-controlled cross-over study lasting up to 3 months with each preparation. Compared with placebo, clomiphene led overall to a 66% increase in mid-luteal serum progesterone levels (from mean 43 nmol/l to 71 nmol/l, p less than 0.001) and a 53% rise in the 3-month cumulative conception rate (from 14.6% to 22.33%, p less than 0.05). The greatest relative increase in conception rates with clomiphene was in women with infertility lasting more than 3 years (3-month rates from 2.9% to 14.4%, p less than 0.05). Differences in conception rates were not related to the rises in progesterone, and there was no carryover effect of clomiphene into the following placebo cycles in terms of progesterone levels or conceptions. The findings suggest that couples with unexplained infertility of less than 3 years duration are essentially normal, but with more than 3 years duration there is often a subtle disorder of ovulation that is corrected by clomiphene therapy.
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Affiliation(s)
- C M Glazener
- University of Bristol, Department of Obstetrics and Gynaecology, Bristol Maternity Hospital, UK
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Glazener CM, Coulson C, Lambert PA, Watt EM, Hinton RA, Kelly NJ, Hull MG. The value of artificial insemination with husband's semen in infertility due to failure of postcoital sperm-mucus penetration--controlled trial of treatment. Br J Obstet Gynaecol 1987; 94:774-8. [PMID: 3311134 DOI: 10.1111/j.1471-0528.1987.tb03725.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Artificial insemination with husband's semen into the cervical canal and uterine cavity (high AIH) was assessed by a randomized controlled prospective study in 46 couples whose infertility was due to failure of sperm mucus penetration, as defined by negative postcoital tests, after excluding all interfering female factors and men with sperm density less than 1 x 10(6)/ml. Seminal analysis was abnormal in 18 of the 46 men and sperm antibodies in semen were detected in 19 of the remaining 28 with normal seminal analysis. Overall, the cumulative conception rate after 6 months with AIH was 4.7 (SE 3.8)% and without treatment was 6.6 (SE 3.9)%. The results were unaffected by the findings on seminal analysis or by the presence or absence of sperm antibodies in semen. AIH appeared to be of no benefit.
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Affiliation(s)
- C M Glazener
- University of Bristol Department of Obstetrics and Gynaecology, Bristol Maternity Hospital
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Hull MG, Glazener CM, Kelly NJ, Conway DI, Foster PA, Hinton RA, Coulson C, Lambert PA, Watt EM, Desai KM. Population study of causes, treatment, and outcome of infertility. BMJ 1985; 291:1693-7. [PMID: 3935248 PMCID: PMC1418755 DOI: 10.1136/bmj.291.6510.1693] [Citation(s) in RCA: 635] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Specialist infertility practice was studied in a group of 708 couples within a population of residents of a single health district in England. They represented an annual incidence of 1.2 couples for every 1000 of the population. At least one in six couples needed specialist help at some time in their lives because of an average of infertility of 21/2 years, 71% of whom were trying for their first baby. Those attending gynaecology clinics made up 10% of new and 22% of all attendances. Failure of ovulation (amenorrhoea or oligomenorrhoea) occurred in 21% of cases and was successfully treated (two year conception rates of 96% and 78%). Tubal damage (14%) had a poor outlook (19%) despite surgery. Endometriosis accounted for infertility in 6%, although seldom because of tubal damage, cervical mucus defects or dysfunction in 3%, and coital failure in up to 6%. Sperm defects or dysfunction were the commonest defined cause of infertility (24%) and led to a poor chance of pregnancy (0-27%) without donor insemination. Obstructive azoospermia or primary spermatogenic failure was uncommon (2%) and hormonal causes of male infertility rare. Infertility was unexplained in 28% and the chance of pregnancy (overall 72%) was mainly determined by duration of infertility. In vitro fertilisation could benefit 80% of cases of tubal damage and 25% of unexplained infertility--that is, 18% of all cases, representing up to 216 new cases each year per million of the total population.
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Birkett CR, Coulson C, Pogson CI, Gull K. Inhibition of secretion of proteins and triacylglycerol from isolated rat hepatocytes mediated by benzimidazole carbamate antimicrotubule agents. Biochem Pharmacol 1981; 30:1629-33. [PMID: 6895032 DOI: 10.1016/0006-2952(81)90390-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
Isolated spinach chloroplasts have been used as a model system for studying the interaction of ozone, a component of photochemical smog, with plant membranes. Ozone bubbled into a suspension of isolated chloroplasts inhibits electron transport in both photosystems without uncoupling ATP production. Photosystem I (reduced 2,6-dichlorophenolindolphenol --> NADP(+)) is a little more sensitive than photosystem II (H(2)O --> 2,6-dichlophenolindolphenol). Ozone does not act as an energy transfer inhibitor, since the drop in ATP production and high energy intermediate (measured by amine-induced swelling) is nearly parallel to the decline in electron transport. A reasonable hypothesis is that ozone disrupts the normal pathway of energy flow from light-excited chlorophyll into the photoacts by a disruption of the components of the membrane but not a general disintegration of the membrane. In addition, ozone does not seem to penetrate into the grana region through the outer membrane of intact plastids, since ozone lowers the bicarbonate-supported O(2) evolution but does not affect the rate of ferricyanide reduction in the same plastids after osmotic disruption. This would indicate that the effect of ozone on green plants, at low concentrations, may be due to the interaction of ozone with the first membrane it contacts and not directly with internal metabolic processes.
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Affiliation(s)
- C Coulson
- Department of Biology and of Biochemistry, University of California, Riverside, California 92502
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